1
|
Gwata D, Ventriglio A, Hughes P, Deahl M. Structural inequalities, knife crime: A qualitative study. Int J Soc Psychiatry 2024; 70:667-678. [PMID: 38557268 DOI: 10.1177/00207640231221092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The importance and impact of youth violence is increasingly being recognised and is a cause of international concern. In the UK, youth violence, specifically knife crime, is on the increase and has resulted in the deaths of many young people. In order to explore the impact of knife crimes on mental health and wellbeing of individuals, a number of focus groups were conducted with 24 professionals from multiple agencies. Qualitative analysis showed various emerging themes, which included ineffective mental health systems, structural violence and inequalities, policing, safety and community engagement, vulnerability and resilience in minority communities. Equity in mental health services, further development and roll-out of public mental health approaches and training accompanied by sufficient resources is needed.
Collapse
Affiliation(s)
| | | | | | - Martin Deahl
- Institute of Psychiatry, Kings College, London, UK
| |
Collapse
|
2
|
Hayanga B, Stafford M, Saunders CL, Bécares L. Ethnic inequalities in age-related patterns of multiple long-term conditions in England: Analysis of primary care and nationally representative survey data. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:582-607. [PMID: 37879907 DOI: 10.1111/1467-9566.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
Little is known about the patterning of multiple long-term conditions (MLTCs) by age, ethnicity and across conceptualisations of MLTCs (e.g. MLTCs with/without mental health conditions [MHCs]). We examined ethnic inequalities in age-related patterns of MLTCs, and combinations of physical and MHCs using the English GP Patient Survey and Clinical Practice Research Datalink. We described the association between MLTCs and age using multilevel regression models adjusting for sex and area-level deprivation with patients nested within GP practices. Similar analyses were repeated for MLTCs that include MHCs. We observed ethnic inequalities from middle-age onwards such as older Pakistani, Indian, Black Caribbean and Other ethnic people had increased risk of MLTCs compared to white British people, even after adjusting for area-level deprivation. Compared to white British people, Gypsy and Irish Travellers had higher levels of MLTCs across the age groups, and Chinese people had lower levels. Pakistani and Bangladeshi people aged 50-74 years were more likely than white people to report MLTCs that included MHCs. We find clear evidence of ethnic inequalities in MLTCs. The lower prevalence of MLTCs that include MHCs among some minoritised ethnic groups may be an underestimation due to underdiagnosis and/or inadequate primary care and requires further scrutiny.
Collapse
Affiliation(s)
- Brenda Hayanga
- Department of Global Health and Social Medicine, King's College London, London, UK
| | | | | | - Laia Bécares
- Department of Global Health and Social Medicine, King's College London, London, UK
| |
Collapse
|
3
|
Heinze N, Jones L, Bertiz F, Saunders E, Gomes RSM. How does the UK public think and feel about people with visual impairment: a review of existing evidence. Front Psychol 2024; 15:1359074. [PMID: 38515970 PMCID: PMC10954816 DOI: 10.3389/fpsyg.2024.1359074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Despite legislation to protect people with visual impairment (V.I.) from discrimination in the United Kingdom (UK), the latter continue to experience overt and covert negative behaviours. Perceived discrimination has been associated with an adverse impact on identity, health and well-being, while negative attitudes have been identified as the biggest barrier to participation in everyday life. This article provides a narrative review of existing evidence of how the UK public treats (behaviours), thinks (perceptions) and feels (attitudes) about people with V.I. Despite limitations, the findings suggest that there is a gap between the behaviours reported by people with V.I. and the attitudes expressed by members of the UK public. Social psychological theories are used to explore possible reasons for this gap, and ways in which it may be addressed. As such, the article provides an example of how social psychological theories can be used to address problems in an applied context.
Collapse
Affiliation(s)
| | - Lee Jones
- BRAVO VICTOR, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Firuzé Bertiz
- Royal National Institute of Blind People, London, United Kingdom
| | - Emma Saunders
- Royal National Institute of Blind People, London, United Kingdom
| | - Renata S. M. Gomes
- BRAVO VICTOR, London, United Kingdom
- Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
4
|
Clarke-Jeffers P, Keyte R, Connabeer K. "Hair is your crown and glory" - Black women's experiences of living with alopecia and the role of social support. HEALTH PSYCHOLOGY REPORT 2024; 12:154-165. [PMID: 38628276 PMCID: PMC11016946 DOI: 10.5114/hpr/177730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/05/2023] [Accepted: 12/28/2023] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Alopecia is an autoimmune condition that results in hair loss, mainly from the scalp. There are three specific types of autoimmune alopecia: alopecia areata (AA; small patches of hair loss), alopecia totalis (AT; total hair loss from the scalp) and alopecia universalis (AU; total hair loss from the scalp and body). Whilst research has explored the experiences of White women living with alopecia, there is a lack of research exploring the impact of alopecia on women in the Black community. The current study aimed to explore Black women's experience of living with autoimmune types of alopecia with a focus on the cultural importance of hair within the Black community and the impact of social support. PARTICIPANTS AND PROCEDURE Seven Black women (age range: 37-68 years; mean age: 51 years) were recruited purposively through alopecia support group organisations and social media to participate in a semi-structured interview; four participants were diagnosed with AA, two participants were diagnosed with AU, and one participant was diagnosed with AT. One-to-one interviews were conducted online, and interpretative phenomenological analysis was used to guide data collection and analysis. RESULTS Participants discussed the significance of hair specifically within the Black community and the complex relationship between psychological wellbeing, coping and seeking support. CONCLUSIONS This novel area, specific to Black women's psychological experience of alopecia, acknowledges the influence of cultural and ethnic differences. The findings suggest that proactive awareness from health professionals and social support groups are needed due to the nuances of Black women's alopecia experience to provide better support and to enhance the quality of life for Black women to manage their alopecia.
Collapse
Affiliation(s)
| | - Rebecca Keyte
- Birmingham City University, Birmingham, United Kingdom
| | | |
Collapse
|
5
|
Webb R, Ford E, Shakespeare J, Easter A, Alderdice F, Holly J, Coates R, Hogg S, Cheyne H, McMullen S, Gilbody S, Salmon D, Ayers S. Conceptual framework on barriers and facilitators to implementing perinatal mental health care and treatment for women: the MATRIx evidence synthesis. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-187. [PMID: 38317290 DOI: 10.3310/kqfe0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background Perinatal mental health difficulties can occur during pregnancy or after birth and mental illness is a leading cause of maternal death. It is therefore important to identify the barriers and facilitators to implementing and accessing perinatal mental health care. Objectives Our research objective was to develop a conceptual framework of barriers and facilitators to perinatal mental health care (defined as identification, assessment, care and treatment) to inform perinatal mental health services. Methods Two systematic reviews were conducted to synthesise the evidence on: Review 1 barriers and facilitators to implementing perinatal mental health care; and Review 2 barriers to women accessing perinatal mental health care. Results were used to develop a conceptual framework which was then refined through consultations with stakeholders. Data sources Pre-planned searches were conducted on MEDLINE, EMBASE, PsychInfo and CINAHL. Review 2 also included Scopus and the Cochrane Database of Systematic Reviews. Review methods In Review 1, studies were included if they examined barriers or facilitators to implementing perinatal mental health care. In Review 2, systematic reviews were included if they examined barriers and facilitators to women seeking help, accessing help and engaging in perinatal mental health care; and they used systematic search strategies. Only qualitative papers were identified from the searches. Results were analysed using thematic synthesis and themes were mapped on to a theoretically informed multi-level model then grouped to reflect different stages of the care pathway. Results Review 1 included 46 studies. Most were carried out in higher income countries and evaluated as good quality with low risk of bias. Review 2 included 32 systematic reviews. Most were carried out in higher income countries and evaluated as having low confidence in the results. Barriers and facilitators to perinatal mental health care were identified at seven levels: Individual (e.g. beliefs about mental illness); Health professional (e.g. confidence addressing perinatal mental illness); Interpersonal (e.g. relationship between women and health professionals); Organisational (e.g. continuity of carer); Commissioner (e.g. referral pathways); Political (e.g. women's economic status); and Societal (e.g. stigma). These factors impacted on perinatal mental health care at different stages of the care pathway. Results from reviews were synthesised to develop two MATRIx conceptual frameworks of the (1) barriers and (2) facilitators to perinatal mental health care. These provide pictorial representations of 66 barriers and 39 facilitators that intersect across the care pathway and at different levels. Limitations In Review 1 only 10% of abstracts were double screened and 10% of included papers methodologically appraised by two reviewers. The majority of reviews included in Review 2 were evaluated as having low (n = 14) or critically low (n = 5) confidence in their results. Both reviews only included papers published in academic journals and written in English. Conclusions The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing perinatal mental health care and effective implementation of perinatal mental health services. Recommendations for health policy and practice These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to perinatal mental health care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to do it. Future work Further research is needed to examine access to perinatal mental health care for specific groups, such as fathers, immigrants or those in lower income countries. Trial registration This trial is registered as PROSPERO: (R1) CRD42019142854; (R2) CRD42020193107. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR 128068) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Elizabeth Ford
- Department of Primary Care and Public Health, Brighton & Sussex Medical School, Falmer, UK
| | | | - Abigail Easter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fiona Alderdice
- Oxford Population Health, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Sally Hogg
- The Parent-Infant Foundation, London, UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | | | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
| | - Debra Salmon
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| |
Collapse
|
6
|
Heinze N, Castle CL. Exploring mental well-being, the emotional impact of visual impairment and experiences of prejudice and discrimination among adults from minority ethnic communities in the UK. Front Public Health 2023; 11:1277341. [PMID: 37808983 PMCID: PMC10558210 DOI: 10.3389/fpubh.2023.1277341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Background Visual impairment (V.I.) has been associated with a negative impact on mental health outcomes, including a process of grief among those who lose their sight. Older adults with V.I. who had experienced discrimination have been found to be at increased risk of depression, loneliness, poorer life satisfaction and poorer quality of life. Adults from minority ethnic communities (MEC) may be at increased risk of V.I. and yet, research on the experiences of MEC adults with V.I. remains limited. This article forms part of a series which explores issues and status among MEC adults living with V.I. in the UK. Methods A secondary analysis of V.I. Lives survey data was performed to explore mental well-being assessed by the short Warwick-Edinburgh Mental Well-being scale (SWEMWBS), the emotional impact of V.I., and prejudice and discrimination among a matched control sample of 77 MEC and 77 adults from white communities (WC). Participants were matched by age, gender, UK region and urban/rural setting. Subgroup analyses were also conducted for the two largest MEC subgroups, Asian (n = 46) and black participants (n = 22). Results There were few statistically significant differences between the groups. MEC participants were significantly more likely than WC participants to rate emotional support to come to terms with their V.I. as important and to feel optimistic about their V.I. but they were significantly less likely to agree that they were receiving the level of emotional support they needed to get on with their life. Within the MEC group, participants from Asian communities had significantly poorer mental well-being, and they were also significantly more likely to agree that the general public were often prejudiced against people with V.I. and less likely to feel optimistic about their V.I. than black participants. Conclusion Although there were few statistically significant differences, participants from Asian communities were more likely to report poor mental and emotional well-being, and experiences of discrimination, than black and white participants. In contrast, participants from black communities fared the same as, or in some cases better than, white participants. Future research will need to confirm these findings and explore reasons for these.
Collapse
Affiliation(s)
| | - Claire L. Castle
- BRAVO VICTOR, London, United Kingdom
- School of Music, Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| |
Collapse
|
7
|
El Baou C, Desai R, Cooper C, Marchant NL, Pilling S, Richards M, Saunders R, Buckman JEJ, Aguirre E, John A, Stott J. Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England. Eur Heart J 2023; 44:1650-1662. [PMID: 37072130 PMCID: PMC10163979 DOI: 10.1093/eurheartj/ehad188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 04/20/2023] Open
Abstract
AIMS People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD. METHODS AND RESULTS A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES-ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were run to estimate the association between reliable improvement from depression and the risk of subsequent incidence of cardiovascular events. After a median follow-up of 3.1 years, reliable improvement from depression symptoms was associated with a lower risk of new onset of any CVD [hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.86, 0.89], coronary heart disease (HR: 0.89, 95% CI: 0.86, 0.92), stroke (HR: 0.88, 95% CI: 0.83, 0.94), and all-cause mortality (HR: 0.81, 95% CI: 0.78, 0.84). This association was stronger in the under 60 compared with the over 60 for all outcomes. Results were confirmed in sensitivity analyses. CONCLUSION Management of depression through psychological interventions may be associated with reduced risk of CVD. More research is needed to understand the causality of these associations.
Collapse
Affiliation(s)
- Céline El Baou
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
| | - Roopal Desai
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Tower Hamlets Memory Service, East London NHS Foundation Trust, London, UK
| | | | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | - Rob Saunders
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
- iCope—Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Elisa Aguirre
- North East London NHS Foundation Trust (NELFT), London, UK
| | - Amber John
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
| | - Joshua Stott
- Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, 1-19 Torrington Place, Camden, London WC1E 7HB, UK
| |
Collapse
|
8
|
Dare O, Jidong DE, Premkumar P. Conceptualising mental illness among University students of African, Caribbean and similar ethnic heritage in the United Kingdom. ETHNICITY & HEALTH 2023; 28:522-543. [PMID: 35912939 DOI: 10.1080/13557858.2022.2104817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 07/18/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Students of African, Caribbean and similar ethnicity (ACE) encounter unique mental health challenges within the Western higher education system, such as feeling constrained in social spaces and perceiving greater stigma about mental health. Students of ACE are also resilient to mental health problems, such as depression, when enduring social inequality. This study aimed to conceptualise mental illness and help-seeking behaviours among university students in the United Kingdom (UK) in the context of their identity as ACE. DESIGN Six university students of ACE in the UK were interviewed about the meaning of mental illness, the influence of ACE culture on mental health and help-seeking by ACE students. Thematic analysis was applied from a socio-constructionist theoretical lens to interpret the interview transcripts. RESULTS Five main themes emerged, namely 'Perceived meanings and attitudes toward mental health problems', 'Beliefs about the non-existence of mental health problem and its spiritual attributions', 'Family dynamics and the 'silencing' of mental health problems', 'Help-seeking for mental health among people of ACE' and 'Stigma and discriminatory responses to mental health issues'. Participants expressed that mental health is an imported concept that people from ACE communities tend to shy away from. A reluctance to discuss mental health problems arose over fear of rejection from families and fear of not being understood by a mental health professional from a different cultural background. CONCLUSION University students of ACE and their families struggle to adopt the Western conceptualisation of mental health. Consequently, there is poor awareness of mental health issues and stigma of mental illness among university students of ACE which pose a barrier to help-seeking for mental health. The limited sample size constrains the ability to draw sound conclusions. Nonetheless, a culturally sensitive conceptualisation of mental health is needed to address poor help-seeking for mental health among people of ACE.
Collapse
Affiliation(s)
- Oluwateniayo Dare
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | | | | |
Collapse
|
9
|
Kabasinguzi I, Ali N, Ochepo P. Mental health experiences and coping strategies of BAME care workers who worked in nursing and residential care homes during the COVID-19 pandemic in Luton, England. BMC Public Health 2023; 23:592. [PMID: 36991365 PMCID: PMC10054189 DOI: 10.1186/s12889-023-15423-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic intensified the risk factors for poor mental health among care workers in the UK. However, there is inadequate evidence on the mental health impact of COVID-19 on Black, Asian, and minority ethnic (BAME) care workers in particular. This study seeks to explore mental health experiences and coping strategies of BAME care workers who worked in nursing and residential care homes during the COVID-19 pandemic. METHOD This is a qualitative study conducted between February and May, 2021 in Luton, England. A sample of n = 15 care workers from BAME background working in nursing and residential care homes were recruited purposively using the snowball sampling technique. In-depth interviews were conducted around topics such as views on COVID-19, the impact of the COVID-19 pandemic on mental health and coping during the COVID-19 pandemic. Data from the interviews was analysed using the Framework Analysis Approach. RESULTS The COVID-19 pandemic had a negative impact on the participants' mental health as they experienced stress, depression, anxiety, trauma and paranoia. The majority of the participants explained that they managed their mental health by belief in God and religious practices, by keeping themselves busy doing activities they were passionate about, following government guidelines on the prevention of COVID-19, seeing the service users happy and some participants managed through support that was offered by the government. However, some participants did not have any support for their mental health. CONCLUSION Issues such as increased workload associated with COVID-19 restrictions engendered mental health problems among BAME care workers, however, the workload only further increased during the pandemic, but the health and social care sector was already affected by heavy workload due to staff shortages and this needs to be addressed through increasing their wages to encourage more people to work in the health and social care sector. In addition, some BAME care workers never received any support for their mental health during the pandemic. Hence, integrating mental health services such as counselling, supportive psychotherapy and recreational therapies in care homes could help to support the mental health of care workers in the COVID-19 era.
Collapse
Affiliation(s)
- Isabella Kabasinguzi
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Luton, Bedfordshire, LU2 8LE, UK
| | - Nasreen Ali
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Luton, Bedfordshire, LU2 8LE, UK.
| | - Peter Ochepo
- Institute for Health Research, University of Bedfordshire, Putteridge Bury, Luton, Bedfordshire, LU2 8LE, UK
| |
Collapse
|
10
|
Bernard K, Wildman JM, Tanner LM, Stoniute A, Still M, Green R, Eastaugh C, Sowden S, Thomson KH. Experiences of Non-Pharmaceutical Primary Care Interventions for Common Mental Health Disorders in Socioeconomically Disadvantaged Groups: A Systematic Review of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5237. [PMID: 37047854 PMCID: PMC10094719 DOI: 10.3390/ijerph20075237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 06/19/2023]
Abstract
Common mental health disorders (CMDs) disproportionately affect people experiencing socioeconomic disadvantage. Non-pharmaceutical interventions, such as 'social prescribing' and new models of care and clinical practice, are becoming increasingly prevalent in primary care. However, little is known about how these interventions work and their impact on socioeconomic inequalities in health. Focusing on people experiencing socioeconomic disadvantage, this systematic review aims to: (1) explore the mechanisms by which non-pharmaceutical primary care interventions impact CMD-related health outcomes and inequalities; (2) identify the barriers to, and facilitators of, their implementation in primary care. This study is a systematic review of qualitative studies. Six bibliographic databases were searched (Medline, ASSIA, CINAHL, Embase, PsycInfo and Scopus) and additional grey literature sources were screened. The included studies were thematically analysed. Twenty-two studies were included, and three themes were identified: (1) agency; (2) social connections; (3) socioeconomic environment. The interventions were experienced as being positive for mental health when people felt a sense of agency and social connection. The barriers to effectiveness and engagement included socioeconomic deprivation and underfunding of community sector organisations. If non-pharmaceutical primary care interventions for CMDs are to avoid widening health inequalities, key socioeconomic barriers to their accessibility and implementation must be addressed.
Collapse
Affiliation(s)
- Kate Bernard
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Josephine M. Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle NE4 5TG, UK
| | - Louise M. Tanner
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Innovation Observatory, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Akvile Stoniute
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Innovation Observatory, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Madeleine Still
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Rhiannon Green
- National Institute for Health and Care Research (NIHR) Innovation Observatory, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Claire Eastaugh
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle NE4 5TG, UK
| | - Katie H. Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne NE2 4AA, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle NE4 5TG, UK
| |
Collapse
|
11
|
Harwood H, Rhead R, Chui Z, Bakolis I, Connor L, Gazard B, Hall J, MacCrimmon S, Rimes KA, Woodhead C, Hatch SL. Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychol Med 2023; 53:1084-1095. [PMID: 34334151 PMCID: PMC9976018 DOI: 10.1017/s0033291721002518] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise. METHODS This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis. RESULTS Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated. CONCLUSIONS Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.
Collapse
Affiliation(s)
- Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Health Service & Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jheanell Hall
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A. Rimes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| |
Collapse
|
12
|
Pedersen ML, Gildberg F, Baker J, Damsgaard JB, Tingleff EB. Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review. Soc Psychiatry Psychiatr Epidemiol 2022; 58:505-522. [PMID: 36454269 PMCID: PMC9713127 DOI: 10.1007/s00127-022-02387-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. METHODS A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey literature searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were explored. RESULTS Altogether, 38 studies were included: 34 were primary studies; 4, reviews. The geographical settings were as follows: Europe (n = 26), Western Pacific (n = 8), Americas (n = 3) and South-East Asia (n = 1). In primary studies, ethnicity was reported according to migrant/national status (n = 16), mixed categories (n = 12), indigenous vs. non-indigenous (n = 5), region of origin (n = 1), sub-categories of indigenous people (n = 1) and religion (n = 1). In reviews, ethnicity was not comparable. The categories of restrictive practices included seclusion, which was widely reported across the studies (n = 20), multiple restrictive practices studied concurrently (n = 17), mechanical restraint (n = 8), rapid tranquillisation (n = 7) and manual restraint (n = 1). CONCLUSIONS Ethnic disparities in restrictive practice use in adult mental health inpatient settings has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to experience restrictive practices than other groups. However, extant research was characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices were used, which hampers researchers' and clinicians' understanding of the issue. Further research in this field may improve mental health practice.
Collapse
Affiliation(s)
- Martin Locht Pedersen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. .,Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark. .,Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark.
| | - Frederik Gildberg
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - John Baker
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Baines Wing, Woodhouse Lane, Leeds, LS2 9JT UK
| | - Janne Brammer Damsgaard
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Ellen Boldrup Tingleff
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.10825.3e0000 0001 0728 0170OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 A, 5000 Odense C, Denmark
| |
Collapse
|
13
|
Manjra II, Russell I, Maninger JK, Masic U. Service user engagement by ethnicity groups at a children's gender identity service in the UK. Clin Child Psychol Psychiatry 2022; 27:1091-1105. [PMID: 35575622 DOI: 10.1177/13591045221102650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Gender service utilisation according to ethnicity is largely under-researched. The present research looked at demographics and service user-engagement according to ethnicity of young people accessing a gender service for children. METHOD A total of 2063 (M = 14.19 years, SD = 2.59, assigned male = 556, 1495 assigned female = 1495, no-specification=12) referrals were included in the analysis. Self-defined ethnicity in financial years (FY) 2016-2017, 2018-2019, and referrer-defined ethnicity in FY 2020-2021 were compared between years, to the national UK-population, and child and adolescent mental health service (CAMHS) averages. Numbers of offered, attended and non-attended appointments were compared across the White and the ethnic minority population (EMP). RESULTS Across years 93.35% young people identified as White (higher than the CAMHS and national population averages); 6.65% as EMP. Service utilisation was similar in FY 2016-2017. In FY 2018-2019, the EMP subgroup was offered and attended more appointments compared to the White subgroup, 'did not attended' average was similar. CONCLUSIONS The majority of young people self-identified with a White ethnic-background. Service engagement was comparable between the EMP and White ethnicity subgroups in 2016-2017, while the EMP group was offered and attended more appointments in 2018-2019. Due to the low EMP group numbers, findings need to be interpreted with caution.
Collapse
Affiliation(s)
- Ilham I Manjra
- Gender Identity Development Service, 9705Tavistock & Portman NHS Foundation Trust, UK.,4956Great Ormond Street Hospital NHS Foundation Trust, UK
| | - Ian Russell
- Gender Identity Development Service, 9705Tavistock & Portman NHS Foundation Trust, UK.,Aldrington House, 8944Sussex Partnership NHS Foundation Trust, UK
| | - Johanna K Maninger
- Gender Identity Development Service, 9705Tavistock & Portman NHS Foundation Trust, UK
| | - Una Masic
- Gender Identity Development Service, 9705Tavistock & Portman NHS Foundation Trust, UK
| |
Collapse
|
14
|
A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01352-0. [PMID: 35767218 DOI: 10.1007/s40615-022-01352-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Measurable differences in the experience and treatment of mental health conditions have been found to exist between different racial categories of community groups. The objective of this research was to review the reported mental health of Black African-Caribbean communities in the UK, determinants of mental health, and interventions to enhance their experiences of mental health services. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was applied. To be included, papers must be published in a peer reviewed journal; report on adult populations (over 18) from any of Black African, Black Caribbean or Black mixed people in the UK; and assess (quantitative), or discuss (qualitative) mental health experiences, determinants of mental health, or interventions intended to enhance experiences of mental health services among the target population. The aims, inclusion criteria, data extraction, and data quality evaluation were specified in advance. Searches were conducted using EBSCO (PsychInfo; MEDLINE; CINAHL Plus; psychology and behavioural sciences collection). The search strategy included search terms relating to the aim. Risk of bias was assessed using a standard tool, records were organised using Endnote, and data were extracted and synthesised using Microsoft Excel. RESULTS Thirty-six studies were included, of which 26 were quantitative and six reported exclusively on Black participants. Black populations were less likely to access mental health support via traditional pathways due to stigma and mistrust of mental health services. Black Africans especially, sought alternative help from community leaders, which increased the likelihood of accessing treatment at the point of crisis or breakdown, which in turn increased risk of being detained under the Mental Health Act and via the criminal justice system. DISCUSSION Findings suggest a cycle of poor mental health, coercive treatment, stigma, and mistrust of services as experienced by Black communities. Evidence was limited by poorly defined ethnic categories, especially where Black populations were subsumed into one category. It is recommended that mental health services work collaboratively with cultural and faith communities in supporting Black people to cope with mental illness, navigate mental health pathways, and provide culturally appropriate advice. Protocol Registration Number PROSPERO CRD42021261510.
Collapse
|
15
|
Hussain B, Hui A, Timmons S, Nkhoma K. Ethnic mental health inequalities and mental health policies in England 1999-2020. JOURNAL OF PUBLIC MENTAL HEALTH 2022. [DOI: 10.1108/jpmh-06-2021-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020.
Design/methodology/approach
This paper aims to present a thematic synthesis of mental health policies published in England from 1999 to 2020. The authors specifically focus on ethnicity-related mental health issues highlighted in policies, policy recommendations and performance measurements of policy implementation.
Findings
Findings from this synthesis demonstrate that ethnic mental health inequalities remain comparable over the past two decades. Ongoing issues include a lack of data on the ethnicity of mental health services users. Where data is available, these highlight ethnic inequalities in access to, experiences of and outcomes of mental health services, as well as a lack of cultural capability in health-care professionals. Policy recommendations have also remained the same during this time and include: collecting data on the ethnicity of service users, raising awareness of the cultural needs of Black and Minority ethnic populations amongst health-care professionals, recruiting BME staff into mental health care services and improving community engagement. The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes.
Practical implications
The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes.
Originality/value
This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020.
Collapse
|
16
|
Dickerson J, Kelly B, Lockyer B, Bridges S, Cartwright C, Willan K, Shire K, Crossley K, Bryant M, Siddiqi N, Sheldon TA, Lawlor DA, Wright J, McEachan RR, Pickett KE. 'When will this end? Will it end?' The impact of the March-June 2020 UK COVID-19 lockdown response on mental health: a longitudinal survey of mothers in the Born in Bradford study. BMJ Open 2022; 12:e047748. [PMID: 35017230 PMCID: PMC8753090 DOI: 10.1136/bmjopen-2020-047748] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore clinically important increases in depression/anxiety from before to during the first UK COVID-19 lockdown and factors related to this change, with a particular focus on ethnic differences. DESIGN Pre-COVID-19 and lockdown surveys nested within two longitudinal Born in Bradford cohort studies. PARTICIPANTS 1860 mothers with a child aged 0-5 or 9-13, 48% Pakistani heritage. MAIN OUTCOME MEASURES ORs for a clinically important increase (5 points or more) in depression (eight item Patient Health Questionnaire (PHQ-8)) and anxiety (Generalised Anxiety Disorder Assessment (GAD-7)) in unadjusted regression analyses, repeated with exposures of interest separated by ethnicity to look for differences in magnitude of associations, and lived experience of mothers captured in open text questions. RESULTS The number of women reporting clinically important depression/anxiety increased from 11% to 20% (95% CI 10%-13%; 18%-22%) and from 10% to 16% (95% CI 8%-11%; 15%-18%), respectively. Increases in depression/anxiety were associated with loneliness (OR=8.37, 95% CI 5.70 to 12.27; 8.50, 95% CI 5.71 to 12.65, respectively); financial (6.23, 95% CI 3.96 to 9.80; 6.03, 95% CI 3.82 to 9.51), food (3.33, 95% CI 2.09 to 5.28; 3.46, 95% CI 2.15 to 5.58) and housing insecurity (3.29, 95% CI 2.36 to 4.58; 3.0, 95% CI 2.11 to 4.25); a lack of physical activity (3.13, 95% CI 2.15 to 4.56; 2.55, 95% CI 1.72 to 3.78); and a poor partner relationship (3.6, 95% CI 2.44 to 5.43; 5.1, 95% CI 3.37 to 7.62). The magnitude of associations between key exposures and worsening mental health varied between ethnic groups.Responses to open text questions illustrated a complex interplay of challenges contributing to mental ill health including: acute health anxieties; the mental load of managing multiple responsibilities; loss of social support and coping strategies; pressures of financial and employment insecurity; and being unable to switch off from the pandemic. CONCLUSIONS Mental ill health has worsened for many during the COVID-19 lockdown, particularly in those who are lonely and economically insecure. The magnitude of associations between key exposures and worsening mental health varied between ethnic groups. Mental health problems may have longer term consequences for public health and interventions that address the potential causes are needed.
Collapse
Affiliation(s)
- Josie Dickerson
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bridget Lockyer
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sally Bridges
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher Cartwright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kathryn Willan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Katy Shire
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Kirsty Crossley
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Najma Siddiqi
- Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
| | - Trevor A Sheldon
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Wolfson Institute for Population Health, Queen Mary University of London and Barts and The London School of Medicine and Dentistry, London, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, The University of Bristol, Bristol, UK
- Population Health Science, University of Bristol Medical School, Bristol, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rosemary Rc McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | | |
Collapse
|
17
|
Tuffour I. Let's talk about the negative experiences of Black mental health service users in England: Now is the moment to consider watchful waiting to support their recovery. Nurs Inq 2021; 29:e12484. [DOI: 10.1111/nin.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Isaac Tuffour
- School of Nursing, Faculty of Education, Health, and Wellbeing University of Wolverhampton Wolverhampton UK
| |
Collapse
|
18
|
Tanner L, Sowden S, Still M, Thomson K, Bambra C, Wildman J. Which Non-Pharmaceutical Primary Care Interventions Reduce Inequalities in Common Mental Health Disorders? A Protocol for a Systematic Review of Quantitative and Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12978. [PMID: 34948587 PMCID: PMC8701146 DOI: 10.3390/ijerph182412978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
Common mental health disorders (CMDs) represent a major public health concern and are particularly prevalent in people experiencing disadvantage or marginalisation. Primary care is the first point of contact for people with CMDs. Pharmaceutical interventions, such as antidepressants, are commonly used in the treatment of CMDs; however, there is concern that these treatments are over-prescribed and ineffective for treating mental distress related to social conditions. Non-pharmaceutical primary care interventions, such as psychological therapies and "social prescribing", provide alternatives for CMDs. Little is known, however, about which such interventions reduce social inequalities in CMD-related outcomes, and which may, unintentionally, increase them. The aim of this protocol (PROSPERO registration number CRD42021281166) is to describe how we will undertake a systematic review to assess the effects of non-pharmaceutical primary care interventions on CMD-related outcomes and social inequalities. A systematic review of quantitative, qualitative and mixed-methods primary studies will be undertaken and reported according to the PRISMA-Equity guidance. The following databases will be searched: Assia, CINAHL, Embase, Medline, PsycInfo and Scopus. Retrieved records will be screened according to pre-defined eligibility criteria and synthesised using a narrative approach, with meta-analysis if feasible. The findings of this review will guide efforts to commission more equitable mental health services.
Collapse
Affiliation(s)
- Louise Tanner
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 8PB, UK; (S.S.); (M.S.); (K.T.); (C.B.); (J.W.)
| | - Sarah Sowden
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 8PB, UK; (S.S.); (M.S.); (K.T.); (C.B.); (J.W.)
| | - Madeleine Still
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 8PB, UK; (S.S.); (M.S.); (K.T.); (C.B.); (J.W.)
| | - Katie Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 8PB, UK; (S.S.); (M.S.); (K.T.); (C.B.); (J.W.)
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle Upon Tyne NE3 3XT, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 8PB, UK; (S.S.); (M.S.); (K.T.); (C.B.); (J.W.)
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle Upon Tyne NE3 3XT, UK
| | - Josephine Wildman
- Population Health Sciences Institute, Newcastle University, Newcastle NE1 8PB, UK; (S.S.); (M.S.); (K.T.); (C.B.); (J.W.)
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) for the North-East and North Cumbria (NENC), Newcastle Upon Tyne NE3 3XT, UK
| |
Collapse
|
19
|
Payne-Gill J, Whitfield C, Beck A. The relationship between ethnic background and the use of restrictive practices to manage incidents of violence or aggression in psychiatric inpatient settings. Int J Ment Health Nurs 2021; 30:1221-1233. [PMID: 34180128 PMCID: PMC9292244 DOI: 10.1111/inm.12873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
Restrictive practices raise considerable concern in mental health inpatient care. Previous studies suggest there are disparities in the use of restrictive practices to manage service users of different ethnic groups. The present study analyses the relationship between ethnicity and the use of restrictive practices to manage incidents of violence or aggression in inpatient settings across an NHS Mental Health Trust. Three years' worth of routinely collected incident data were analysed using multilevel multiple logistic regression to assess the relationship between ethnic group and four types of restrictive practices: physical restraint (without prone), physical restraint (with prone), seclusion, and rapid tranquilization. We controlled for a range of demographic variables and the type and severity of the incident. Adjusted analyses showed that service users with a Black African [Odds Ratio = 1.96, 95% CI: 1.36-2.83, P < 0.001], Black Caribbean [Odds Ratio = 1.76, 95% CI: 1.08-2.85, P = 0.022], Black Other [Odds Ratio = 1.76, 95% CI: 1.27-2.44, P = 0.001], and Mixed [Odds Ratio = 1.88, 95% CI: 1.11-3.18, P = 0.019] ethnic background were more likely to be secluded, and Black Caribbean [Odds Ratio = 1.45, 95% CI: 1.02-2.07, P = 0.040] service users were more likely to be restrained in prone position. We did not detect differences in the use of physical restraints without prone or in the use of rapid tranquilization. Our findings illustrate the need to focus on outcomes for different ethnic groups when implementing restraint reduction programmes.
Collapse
Affiliation(s)
| | - Corin Whitfield
- South London and Maudsley NHS Mental Health Trust, London, UK
| | - Alison Beck
- South London and Maudsley NHS Mental Health Trust, London, UK
| |
Collapse
|
20
|
Platt IA, Kannangara C, Carson J, Tytherleigh M. Heuristic assessment of psychological interventions in schools (HAPI Schools). PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ian A. Platt
- Department of Psychology, School of Education and Psychology University of Bolton Bolton England
| | - Chathurika Kannangara
- Department of Psychology, School of Education and Psychology University of Bolton Bolton England
| | - Jerome Carson
- Department of Psychology, School of Education and Psychology University of Bolton Bolton England
| | - Michelle Tytherleigh
- Department of Psychology, School of Psychology University of Chester Chester England
| |
Collapse
|
21
|
Bernardi J, Engelbrecht A, Jobson L. The impact of culture on cognitive appraisals: Implications for the development, maintenance, and treatment of posttraumatic stress disorder. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jessica Bernardi
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia,
| | - Alberta Engelbrecht
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia,
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,
| | - Laura Jobson
- Monash Institute of Cognitive and Clinical Neuroscience, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia,
| |
Collapse
|
22
|
Patel K, Bosqui T, Kouvonen A, Donnelly M, Väänänen A, Bell J, O'Reilly D. Unmet need for mental health medication within the migrant population of Northern Ireland: a record linkage study. J Epidemiol Community Health 2020; 75:245-250. [PMID: 33130576 DOI: 10.1136/jech-2019-212774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 08/30/2020] [Accepted: 09/08/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Migrant populations are particularly at risk of not receiving the care for mental ill-health that they require for a range of reasons, including language and other barriers to health service access. This record linkage study compares, for migrant and settled communities, the likelihood that a person in Northern Ireland with poor mental health will receive psychotropic medication. METHODS A cohort of 78 267 people aged 16-64 years (including 1736 migrants) who reported chronic poor mental health in the 2011 Census records was followed for 15 months by linkage to a centralised prescribing data set to determine the rates of pharmacological treatment. Logistic regression analyses quantified the relationship between psychotropic medication uptake and migrant status, while accounting for relevant demographic and socioeconomic factors. RESULTS Overall, 67% of the migrants with chronic poor mental health received at least one psychotropic medication during the study period, compared to 86% for the settled population; this equates to an OR of 0.32 (95% CI 0.29 to 0.36) in the fully adjusted models. Adjustment for English proficiency did not significantly alter these models. There was also considerable variation between individual migrant groups. CONCLUSION Although this study suggests substantial unmet need for treatment of poor mental health among the migrant population of Northern Ireland, further qualitative studies are required to better understand how different migrant groups respond to mental ill-health.
Collapse
Affiliation(s)
- Kishan Patel
- Administrative Data Research Centre - Northern Ireland, Belfast, UK .,Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Tania Bosqui
- Administrative Data Research Centre - Northern Ireland, Belfast, UK.,Department of Psychology, American University of Beirut, Beirut, Lebanon
| | - Anne Kouvonen
- Administrative Data Research Centre - Northern Ireland, Belfast, UK.,Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland
| | - Michael Donnelly
- Administrative Data Research Centre - Northern Ireland, Belfast, UK.,Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland.,School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Justyna Bell
- Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway
| | - Dermot O'Reilly
- Administrative Data Research Centre - Northern Ireland, Belfast, UK.,Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
23
|
Germain S, Yong A. COVID-19 Highlighting Inequalities in Access to Healthcare in England: A Case Study of Ethnic Minority and Migrant Women. FEMINIST LEGAL STUDIES 2020; 28:301-310. [PMID: 33071485 PMCID: PMC7549079 DOI: 10.1007/s10691-020-09437-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 05/29/2023]
Abstract
Our commentary aims to show that the COVID-19 pandemic has amplified existing barriers to healthcare in England for ethnic minority and migrant women. We expose how the pandemic has affected the allocation of healthcare resources leading to the prioritisation of COVID-19 patients and suspending the equal access to healthcare services approach. We argue that we must look beyond this disruption in provision by examining existing barriers to access that have been amplified by the pandemic in order to understand the poorer health outcomes for women in ethnic minority and migrant communities. The reflection focuses on racialised medical perceptions, gendered cultural norms including information barriers and stigma, and specific legal barriers.
Collapse
Affiliation(s)
- Sabrina Germain
- The City Law School, City, University of London, Northampton Square, Clerkenwell, London, EC1V 0HB UK
| | - Adrienne Yong
- The City Law School, City, University of London, Northampton Square, Clerkenwell, London, EC1V 0HB UK
| |
Collapse
|
24
|
Platt IA, Kannangara C, Tytherleigh M, Carson J. The Hummingbird Project: A Positive Psychology Intervention for Secondary School Students. Front Psychol 2020; 11:2012. [PMID: 32849165 PMCID: PMC7426523 DOI: 10.3389/fpsyg.2020.02012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
Mental health in schools has attracted a lot of attention in recent years. Positive Psychology Interventions (PPIs) in secondary schools have been shown to improve mental health outcomes for students. Previous PPIs have tended to be delivered by trained Psychology specialists or have tended to focus on a single aspect of Positive Psychology such as Mindfulness. The current study involved 2 phases. Phase 1 was a pilot PPI, delivered by current university students in Psychology, which educated secondary school students (N = 90) in a variety of Positive Psychology concepts. Phase 2 involved delivering the PPI to secondary school students (N = 1,054). This PPI, the Hummingbird Project, led to improvements in student well-being, as measured by the World Health Organization Well-Being Index (WHO-5). The intervention also led to improvements in student resilience, as measured by the Bolton Uni-Stride Scale (BUSS), and hope, as measured by the Children's Hope Scale (CHS). Results are discussed in the context of their implications for the future of psychological intervention in secondary school settings.
Collapse
Affiliation(s)
- Ian Andrew Platt
- School of Education and Psychology, University of Bolton, Bolton, United Kingdom
| | | | | | - Jerome Carson
- School of Education and Psychology, University of Bolton, Bolton, United Kingdom
| |
Collapse
|
25
|
Understanding Mental Health: What Are the Issues for Black and Ethnic Minority Students at University? SOCIAL SCIENCES 2018. [DOI: 10.3390/socsci7100196] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Black and Minority Ethnic (BME) communities continue to experience inequalities within the United Kingdom (UK) mental health system despite major government policy initiatives. Access to higher education for many ethnic minorities remains problematic. Within higher education, BME students consistently face barriers in terms of accessing culturally appropriate services including a lack of cultural understanding, communication issues, and where and how to seek help. This paper attempts to address the problems facing ethnic minorities with regard to accessing mental health services at university. Importantly, this paper highlights that barriers to accessing mental health support for ethnic minorities directly impact upon attainment outcomes and psychological well-being. This study utilizes the narratives of 32 BME university students to examine the impact of negotiating racial inequality and discrimination at university and the impact upon mental health. Aspects examined considered the impact of belonging, isolation, and marginalization on mental health and how this consequently affects university participation for BME students. Utilizing a thematic analysis paradigm, the key findings presented point towards differential healthcare outcomes for ethnic minority university students experiencing mental illness. The empirical findings in this paper suggest that currently ethnic minority service users experience overt discrimination and a lack of access to culturally appropriate services that are cognizant of the racialized plights faced by BME individuals. These findings inform an overarching dialogue, which suggests that mental health service providers need to work more collegially with people from BME communities prior to service design and delivery. Furthermore, the findings suggest that, upon presenting mental health issues, information should be made available in appropriate languages for ethnic minorities to support understanding about their illnesses and how they can seek professional intervention and help. Conclusions and recommendations provided advocate greater diversification of mental health support systems for ethnic minority students within universities. Conclusions drawn will also consider how existing systems can function to dismantle racial inequality within the mental health profession.
Collapse
|
26
|
Asthana S, Gibson A, Bailey T, Moon G, Hewson P, Dibben C. Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Sheena Asthana
- School of Government, University of Plymouth, Plymouth, UK
| | - Alex Gibson
- School of Government, University of Plymouth, Plymouth, UK
| | - Trevor Bailey
- College of Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Graham Moon
- School of Geography and the Environment, University of Southampton, Southampton, UK
| | - Paul Hewson
- School of Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|